Obstetric ICU admissions and their outcomes in Ayder Comprehensive Specialized Hospital: Institution based retrospective study

Abstract

Introduction: Critically ill obstetric patients (Near misses) present a unique clinical challenge to the health care workers and become more accurately reflection of the impact of obstetric care on the wellbeing of women. The intensive care unit (ICU) is a health care delivery service for patients who are critical with potentially recoverable diseases. They can benefit from more detailed observation, monitoring, and treatment than is generally available in the standard lying-in ward or department. So Obstetric ICU admission (obstetric transfer to ICU) becomes one indicator of pronounced maternal morbidity. Since the start of our ICU in Ayder Comprehensive specialized hospital, there were critically sick obstetric patients being admitted to the ICU. But systematic analysis of the outcome of these patients was never assessed; this study was therefore conducted to evaluate the obstetric ICU admissions and their outcomes in the five years before the study.
Objective: To assess the obstetric ICU admissions and their outcomes in Ayder Comprehensive Specialized Hospital (ACSH), Mekelle, Tigray, Ethiopia.
Methods: A retrospective chart review was conducted for Obstetric patients admitted to ACSH Adult ICU from January 1, 2013 – December 31, 2017.
Result: -The hospital records of 75 patients out of 102 obstetrics patients were retrieved and analyzed from the total 2071 AICU (Adult Intensive Care Unit) admitted patients over a period of five years. And a total of 13521 deliveries giving an ICU admission rate of 7.54 per 1000 deliveries and the 102 obstetric patients admitted to AICU makes ICU utilization rate of 4.92%. Pregnancy-induced hypertension (PIH) (32 %, n=24/75) and severe obstetric hemorrhage (13.3%, n=10/75) were the most frequent indications for Obstetric ICU admission. There were 18 (17.65%) maternal deaths in the course of these 102 Obstetrics ICU admitted patients in the study period; and the retrieved records of 11patients analyzed. Multiorgan failure (54.5%) and disseminated intravascular coagulation (27.3%) were the most common causes of maternal death in this study.
Conclusion: pregnancy induced hypertension was the most frequent indication for ICU admission followed by Obstetric hemorrhage. Early detection and management of these severe obstetric complications would have reduced the complications and maternal mortality.